Hepatitis E virus-associated cryoglobulinemia in solid-organ-transplant recipients.

Abstract

BACKGROUND & AIMS:

An association between hepatitis E virus (HEV) infection and cryoglobulinemia has been suggested. The aims of this study were to assess the prevalence of cryoglobulinemia during HEV infection in solid-organ-transplant (SOT) recipients, to describe its outcomes under ribavirin therapy and to evaluate its effects on kidney function and histology.

METHODS:

Between November 2005 and June 2016, 128 cases of HEV infection were diagnosed among SOT recipients followed in our institution. Cryoglobulinemia data obtained from 66 patients during acute-phase HEV and 51 patients during chronic-phase HEV were compared to a historical control group of 89 SOT recipients without HEV markers. Cryoglobulins were also monitored in a group of 43 patients treated by ribavirin.

RESULTS:

The prevalence of cryoglobulinemia was increased in HEV-infected SOT patients during a chronic phase (52.9%) compared to HEV-infected SOT patients at acute phase (36.4%) (P = .1) and to HEV-negative SOT patients (23.6%) (P < .001). HEV infection was identified as an independent predictive factor for cryoglobulinemia (OR 2.3, CI 95%: 1.17-4.55, P = .02). After ribavirin therapy and HEV clearance, the prevalence of cryoglobulin was significantly decreased from 53.5% to 20.9% (P = .003). Kidney function was significantly worse and proteinuria tended to be higher in chronically HEV-infected patients with cryoglobulinemia compared to those without cryoglobulinemia. Membranoproliferative glomerulonephritis was diagnosed in 2 patients, of which 1 had detectable cryoglobulinemia.

CONCLUSIONS:

In conclusion, a relationship between HEV and cryoglobulin formation seems to exist. However, the clinical impact of cryoglobulinemia in SOT patients infected with HEV has to be confirmed.

• Authors: Olivier Marion, Florence Abravanel, Arnaud Del Bello, Laure Esposito, Sebastien Lhomme, Bénédicte Puissant-Lubrano, Laurent Alric, Stanislas Faguer, Jacques Izopet, Nassim Kamar
• Journal: Liver international : official journal of the International Association for the Study of the Liver (Liver Int) Vol. 38 Issue 12 Pg. 2178-2189 (12 2018) ISSN: 1478-3231 [Electronic] United States
• PMID: 29845733 (Publication Type: Journal Article)
• Copyright: © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Chemical References

• Antiviral Agents
• Ribavirin

Topics

• Adult
• Antiviral Agents (therapeutic use)
• Cryoglobulinemia (virology)
• Female
• France
• Hepatitis E (complications, diagnosis, drug therapy)
• Humans
• Immunocompromised Host
• Kidney (physiopathology)
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Ribavirin (therapeutic use)
• Transplant Recipients